Provider Demographics
NPI:1508403411
Name:LINKROUM, MARISA N (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:N
Last Name:LINKROUM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:NICOLE
Other - Last Name:ASTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 416495
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6495
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:
Practice Address - Street 1:168 FRANKLIN CORNER RD., BLDG 1
Practice Address - Street 2:SUITE 110
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1279
Practice Address - Country:US
Practice Address - Phone:609-299-1279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01907900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist